A MeSH-supported study has shown the risk of death from COVID-19 is around twice as high in people living with HIV and that 8.5% of COVID-19 deaths in South Africa’s Western Cape province are attributable to HIV.
The study looked at approximately 3.5 million adults receiving public sector health care in the Western Cape province, both in the community and in hospital. Most other studies on COVID-19 in people with HIV have only included hospitalised patients. The analysis investigated risk factors for death in people with a positive SARS-CoV-2 test whilst adjusting for age, sex, location and co-morbidities.
People who died were substantially older than people who were diagnosed with COVID-19 and survived (63 years vs 37 years). People who died also had a higher prevalence of diabetes, hypertension, chronic kidney disease, chronic obstructive pulmonary disease, and previous or current TB.
HIV prevalence was similar across those not diagnosed with COVID-19, those with COVID-19 who survived, and those with COVID-19 who died, at around 17%. However, there were several differences in the characteristics of HIV-positive and HIV-negative people who died. Forty percent of HIV-positive people who died of COVID-19 were under 50 years of age, compared to 13% in HIV-negative people. People living with HIV were much more likely to have had a previous (37%) or current (14%) tuberculosis infection compared to HIV-negative people.
Living with HIV was associated with a twofold increase in risk of COVID-19 death (adjusted hazard ratio 2.14; 95% confidence interval 1.70-2.70). Boulle et al acknowledged that it is possible that this could be an overestimation due to confounding factors, such as socio-economic status, or unrecorded comorbidities but sensitivity analysis supported the conclusion that people living with HIV are at a greater risk of COVID-19 death.
This is a hugely important study: it is the largest yet undertaken on COVID-19 and HIV in Africa. and highlights the need to consider people living with HIV as a high risk-group for severe COVID-19. It is well worth your time to read.
The full text of the paper is available open access from Oxford University Press journals.
